Metastatic Castration-Resistant Prostate Adenocarcinoma with Tp53 Gene Mutation: Can It Result in Contrasting Organ-Specific PET-CT Imaging Characteristics with 68Ga-PSMA-11 and 18F-FDG?

In metastatic prostate adenocarcinoma, the dual-tracer PET imaging approach with gallium-68 (68Ga)-prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET)/computed tomography (CT) and fluorodeoxyglucose (FDG) PET/CT provides valuable insights into the disease's receptor-based and glucose metabolic imaging features. In our case series, we highlight a flip-flop pattern observed on both imaging modalities in metastatic castration-resistant prostate adenocarcinoma cancer (mCRPC) patients with confirmed Tp53 mutations. While skeletal metastases showed both PSMA expression as well as FDG avidity, the lymph nodal and hepatic metastases showed only FDG avidity and no PSMA expression. These contrasting findings suggest that Tp53 mutations may influence tumor biology in mCRPC, potentially altering PET-CT imaging signatures in different organs, with its potential implications for treatment decisions. The presented case series in this communication indicate a possible association between Tp53 mutation and organ-specific molecular imaging heterogeneity in mCRPC patients, highlighting the role of dual-tracer PET in personalized theranostic planning in mCRPC.